Management of the Hip Complex

Question 1

Besides the labor what are two ligaments within the hip capsular?

Answer 1

ligamentum teres- leads to AVN if damaged

Transverse ligament- completes 180 degree rim around acetabulum

Question 2

What are three major hip ligaments outside the capsule?

Answer 2

iliofemoral- Y ligament
pubofemoral
ischiofemoral-

Question 3

What are the three bursae in the hip region that are clinically significant?

Answer 3

trochanteric, iliopectineal, ischiogluteal

Question 4

What is connected to the trochanteric bursa?

Answer 4

ITB, glute med and min, greater troch.

Question 5

How can you distinguish between a bursa injury and ms tendon injury?

Answer 5

ms injury tends to be more localized to a specific spot such as ms attachment

bursa tends to be spread in a larger area

Question 6

What is connected to the iliopectineal bursa?

Answer 6

iliopsoas, iliopectineal eminence along superior rim of acetabulum

Question 7

What is connected to ischiogluteal bursa?

Answer 7

common hamstring tendon and ischial tube

check for avulsion fracture

Question 8

What structures are in the femoral triangle?

Answer 8

femoral vein, artery and nerve

Question 9

What are the borders of femoral triangle?

Answer 9

lateral border- sartorius
medial- adductor longus
superior- inguinal ligament
floor- iliopsoas tendon

Question 10

What is open packed position of hip?

Answer 10

greatest laxity 10-30 of flexion, 10-30 abduction, 0-5 degrees ER

Question 11

What is version of the hip joint?

Answer 11

position in space relative to a body plane, head and neck with frontal plane

Question 12

What is torsion of hip joint?

Answer 12

twist of bone along a longitudinal axis, head and neck with condyles

Question 13

What is normal degree of inclination of femoral head is anterior relative to distal femoral condyles?

Answer 13

12-15 degrees

Question 14

What is ante version?

Answer 14

angle of inclination over 15 degrees causes compensatory IR leading to shortened IR muscles and limited ER

Question 15

What are functional results of ante version?

Answer 15

toes pointed in, increased demand on posterolateral hip and thigh soft tissues (ITB, vastus lateralis, bicep femoris), angle of gait decreased

Question 16

What are common symptoms of ante version?

Answer 16

ITB, piriformis, trochanteric bursitis, patellafemoral dysfunction

gait- late phase supination due to progression of weight bearing forces

Question 17

What is W sitting?

Answer 17

potential early cause of Anteversion, common in kids with low tone

Question 18

What is retroversion?

Answer 18

angle of inclination is below 12 degrees leads to compensatory ER which limits IR and shortens ER muscles

Question 19

What are functional effects of retroversion?

Answer 19

increases demand of anteromedial hip and thigh soft tissue structures (iliopsoas, Adductors, rectus femoris), resulting in toe out

Question 20

What are common symptoms of retroversion?

Answer 20

iliopsoas strain, addcutor strain, psoas bursitis

gait: late phase of pronation due to progression of weight bearing forces

Question 21

What happens in transverse plane during gait for toe in?

Answer 21

early stance- pronation, subtalar adducted

late- supination COM lateral to STJ axis

Question 22

What happens in transverse plane during gait for toe out?

Answer 22

early stance: talus abducted, supination

late- pronation, COM medial to STJ axis

Question 23

What is angle of inclination of femoral neck in frontal plane?

Answer 23

125 degrees

Question 24

What is coxa valga?

Answer 24

angle of inclination greater than 125 degrees, leading to femoral abduction and genu varum

Question 25

What are functional implications of coxa valga?

Answer 25

narrow base of support, medial knee compression lateral knee tension, greater need for STJ pronation during gait to bring calcaneus to ground

Question 26

What is coxa vara?

Answer 26

angle of inclination less than 125 degrees leading to femoral adduction resulting in genu valgum

Question 27

What are functional implications of coxa vara?

Answer 27

wide base of support, greater need of STJ to supinate during gait to bring lateral calcaneus to ground , medial knee tension, lateral knee compression

Question 28

What are primary hip flexors?

Answer 28

sagittal plane: iliopsoas, sartorius, TFL, rectus femoris, adductor longus, pectineus

Question 29

What are primary hip extensors?

Answer 29

Sagittal plane: glute max, adductor magnus, bicep femoris, semitendinosus, semimembranous

Question 30

What is the major force couple in sagittal plane?

Answer 30

hip extensors and abdominals posterior pelvic tilt

Question 31

What are primary external rotators?

Answer 31

transverse plane: glute max, piriformis, QF

Question 32

What are ER in hip similar to in the rest of the body?

Answer 32

Rotator cuff as they provide joint compression

Question 33

What is important to remember about ER of hip?

Answer 33

their action depends on position of the femur for example if hip is flexed over 90 most become IR

Question 34

What are primary adductors in frontal plane?

Answer 34

pectineus, adductor longus, gracilis, adductor brevis, adductor magnus

Question 35

Why are adductors strains so prevalent?

Answer 35

because the are under constant triplanar biomechanical demand as they are working maximally throughout ROM

Question 36

What are primary frontal planes abductors?

Answer 36

glute med, glute min, TFL

Question 37

How much BW equivalent is required to prevent Trendelenburg during SLS?

Answer 37

2 times

Question 38

What can tears in glute med and glute min be commonly diagnosed as?

Answer 38

trochanteric bursitis

Question 39

What are best exercises for glute med?

Answer 39

side bridge/plank, SL hip ABD, SLS, lateral band walk, hip hike

Question 40

What are best exercises for glute max?

Answer 40

bird dog, unilateral bridge, SLS, SLDL, front plank with Hip ext, glute squeeze